Current use of antiretroviral treatment.

INTRODUCTION: Antiretroviral therapy for HIV infection has transformed it from a terminal illness to a chronic manageable condition. This review summarizes the history of the treatment and explains the current practice in the field, including uses in prevention strategies. SOURCES OF DATA: National and international guidelines, important publications in peer reviewed literature and recent important conference abstracts. AREAS OF AGREEMENT: There is a broad agreement on the choice of drug regimens and on the need to treat patients with symptomatic HIV infection and with CD4 cell counts less than 350 cells/mm(3). The need to adapt therapy to individual circumstances is also well accepted, e.g. hepatitis co-infection and pregnancy. AREAS OF CONTROVERSY: Treatment of acute HIV infection and the optimum time to commence therapy in asymptomatic chronic infection remain controversial. Use of antiretrovirals for prevention, e.g. pre-exposure and post-exposure prophylaxis, is still developing. GROWING POINTS: This article summarizes the current use of anti-HIV medication and the evidence behind it for the non-specialist. AREAS TIMELY FOR DEVELOPING RESEARCH: New strategies for using current drugs, the best use of newly available drugs and new uses of antiretroviral drugs, such as in prevention of HIV transmission, are key areas for research. Further research addressing the question of when to start antiretrovirals and assessing their long-term effects is also needed.